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Am J Kidney Dis. 2018 Jul;72(1):136-148. doi: 10.1053/j.ajkd.2017.11.021. Epub 2018 Feb 22.

Management of Acute Kidney Injury: Core Curriculum 2018.

Author information

1
Division of Hospital Medicine, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California San Francisco, University of California, San Francisco, CA.
2
Division of Nephrology, Department of Medicine, University of California, San Francisco, CA.
3
Division of Nephrology, Department of Medicine, University of California, San Francisco, CA; Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, CA. Electronic address: kathleen.liu@ucsf.edu.

Abstract

Acute kidney injury (AKI) is a heterogeneous disorder that is common in hospitalized patients and associated with short- and long-term morbidity and mortality. When AKI is present, prompt workup of the underlying cause should be pursued, with specific attention to reversible causes. Measures to prevent AKI include optimization of volume status and avoidance of nephrotoxic medications. Crystalloids are preferred over colloids for most patients, and hydroxyethyl starches should be avoided. Volume overload in the setting of AKI is associated with adverse outcomes, so attention should be paid to overall fluid balance. Currently there are no targeted pharmacotherapies approved for the treatment of AKI. The optimal timing of renal replacement therapy in critically ill patients with AKI is unclear, but is an area of active investigation. Recent studies suggest that AKI is not a "self-limited" process, but is strongly linked to increased risk for chronic kidney disease, subsequent AKI, and future mortality.

KEYWORDS:

AKIN; Acute kidney injury (AKI); KDIGO; RIFLE; critical care; fluid balance; intrarenal; postrenal; prerenal; renal replacement therapy (RRT); review; serum creatinine (Scr); treatment; urine output; volume status

PMID:
29478864
DOI:
10.1053/j.ajkd.2017.11.021

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